Associated Team

TOFMOD: Predictive modeling for tetralogy of Fallot patients 

  • TOFMOD is an Inria Associated Team funded by Inria France and Pediatric Cardiac MR Imaging Lab of UT Southwestern Medical Center Dallas (UTSW) and formed by researchers from the M3DISIM team (Inria Saclay), UTSW Medical Center Dallas and additional participants from MRI and cardiology departments (London, Prague).
  • The aim of TOFMOD team is to address various issues in patients with repaired Tetralogy of Fallot (rTOF) by including biomechanical modeling, i.e. adding physics and physiology into the loop of clinical exams and management.
  • In the patients with rTOF we identified problems of optimal timing of intervention as e.g. a pulmonary valve replacement therapy (PVR) or branch pulmonary artery (PA) stenting. In addition, we would like to increase understanding of failing of LV in what-is-classicaly-known to be an "RV disease", as rToF patients are known to develop LV failure earlier than the general population.
  • While tackling the cohort of rTOF patients - i.e. a typical disease of right ventricle (RV), RV outflow tract (RVOT) including pulmonary valve, and branch pulmonary arteries (PA's) - the methods are in essence more universal and we are in fact exploring their applicability between LV & RV, pulmonary & aortic valve, and pulmonary artery & aorta.
  • These leads to three main objectives of ToFMOD:
    1. Ventricular mechanics and its biomechanical modeling: aiming to optimize the timing of PVR
    2. Ventricular motion characterization augmented by modeling
    3. Characterizing the flow through pathological valve by using fluid mechanics aiming to optimize the timing of branch-PA stenting
  • PVR is the therapy of choice in volume-overloaded RV due to insufficient pulmonary valve. The dilated RV may even shrink back to normal size, if the PVR is performed "not too late". The lifespan of the replaced pulmonary valve is typically 5-10 years, i.e. the rToF patients need several re-interventions during their life. Therefore, the PVR procedure tends to be postponed to "as late as possible", however prior to an irreversibility of the RV dilatation or other adverse effects occur.
  • Branch PA stenosis is typically managed by stenting. The timing of re-stenting is however not clear, and assessing the already stented artery by magnetic resonance imaging may be challenging due to artifacts caused by the stent. Couplling of image data with a model has the potential to augment the information from clinical exam.
  • A book chapter  named "Translational Cardiovascular Modeling, Tetralogy of Fallot and Modeling of Diseases" (preprint on HAL) demonstrates a number of problems associated to TOFMOD. The chapter will appear in the book Modeling Biomaterials (Birkhauser, eds. Josef Malek and Endre Suli).

Members of the TOFMOD Associated Team